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NPI Code Detail

MEDICARE: EDWARD ZHAO DA BAKER

MEDICARE:   EDWARD ZHAO DA BAKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-21-178302IN

General Provider Information

NPI Number : 1891415105
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD ZHAO DA BAKER
Provider Business Mailing Address
First Line : 11122 E LAKESIDE CIR
Second Line :
City : ROCKVILLE
State : IN
Zip : 47872-8034
Country : US
Telephone Number : 317-540-5094
Fax Number :
Provider Business Practice Location Address
First Line : 7105 GALEN DR W
Second Line :
City : AVON
State : IN
Zip : 46123-8450
Country : US
Telephone Number : 317-813-4690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2022
Last Update Date : 08/29/2022

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Directions to “ EDWARD ZHAO DA BAKER ” Practice Location

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